Hinojosa faces legal and federal hurdles in Texas Medicaid push
State law restricts the governor's authority, and new federal work requirements could raise the state's share of expansion costs starting in January.
By Grace Almasi ·
Gina Hinojosa has declared Medicaid expansion a top priority for her incoming administration, but she faces immediate structural obstacles. A state law prevents the governor from altering Medicaid eligibility requirements without legislative approval, and a Republican-controlled Texas Senate will likely block any bill sent to their chamber next year.
The issue gained momentum following last week's election, in which Hinojosa and Lt. Gov.-elect Vikki Goodwin defeated their Republican opponents. Democrats also secured control of the Texas House, though they still lack the supermajority needed to override a gubernatorial veto or pass legislation easily through the Senate.
Hinojosa has been vocal about the state's uninsured population, which stands at 16 percent of residents. That figure leads the nation. Since 2015, the number of Texans without coverage has climbed to more than 5 million. Under current rules, no childless working-age adult can qualify for the program, which is limited to low-income children, new mothers, and the elderly.
Hinojosa told KPRC in Houston after the election that ensuring every child has quality healthcare is a moral imperative. She stated that the state must expand Medicaid to close the gap. However, it is not yet clear if her legal team believes the governor can unilaterally direct the Texas Health and Human Services Commission to file an expansion plan with the federal government.
Federal policy adds another layer of complexity. The One Big Beautiful Bill Act of 2025 imposes new work-reporting requirements on Medicaid recipients under age 65. Starting in January, these individuals must work at least 80 hours a month and earn the federal minimum wage to retain coverage. State Rep. Donna Howard, D-Austin, noted that these rules could increase administrative costs for Texas.
Texas would be responsible for 10 percent of the expansion costs, a share that could rise due to the new federal monitoring requirements. Howard suggested a trigger bill as a potential solution. This legislative approach would activate expansion only if the incoming Democratic majority in Congress repeals the costliest federal restrictions.
Advocates argue the financial burden is manageable. Expanding Medicaid would provide coverage for families of four earning between $4,000 and $44,000 annually. Charles Miller, director of Health and Economic Mobility Policy at Texas 2036, said the move would eliminate the coverage gap for those who earn too much for Medicaid but too little for affordable care subsidies.
Dr. Edwin Park, a research professor at Georgetown University, said hospitals would benefit from improved operating margins as uncompensated care decreases. Local governments currently spend hundreds of millions of dollars annually to treat uninsured residents. Hinojosa's team is now working to determine the most viable path forward, whether through executive action or legislative negotiation.
